Provider Demographics
NPI:1487750493
Name:DIABETIC RESOURCES AND MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:DIABETIC RESOURCES AND MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-895-3888
Mailing Address - Street 1:4160 WESTPORT RD STE E
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 WESTPORT RD STE E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2746
Practice Address - Country:US
Practice Address - Phone:502-895-3888
Practice Address - Fax:502-895-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012840Medicaid
KY5045680001Medicare NSC